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Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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5.24.2018 QI 02 What do you mean by “resource stewardship”?

By resource stewardship, we mean ensuring responsible use of resources while providing high quality, efficient, patient-centered primary care as it relates measures affecting health care costs and care coordination.

PCMH 2017

5.24.2018 CM 02 How do practices select the patient population for Competency B?

Practices use the patients identified in CM 02 as the denominator for criteria in Competency B. To earn credit for each criterion, practices must document the required information for at least 75 percent of those patients. For evidence, practices must either complete the Record Review Workbook or submit a report.

  • Practices that submit the Record Review Workbook must provide an example of each criterion, demonstrating how providing information is documented in the medical record.
  • Practices that submit a report must provide a report with at least three months of recent data showing the number of patients who had the criterion-specific information documented in their medical record (numerator) out of the total number of patients identified in CM 02 (denominator).

PCMH 2017

5.24.2018 KM 12 Are practices required to provide a separate letter, phone script or other method for each service needed?

No. Practices may demonstrate the same evidence if:

  • The same method of outreach is used for each service.
  • Practices demonstrate an example of the outreach used. 

Practices must provide information about how the letter, phone script or other method is modified for each service reminder. 

PCMH 2017

5.24.2018 CM 02 If a patient sample for the Record Review Workbook includes both pediatric and adult patients, do practices need to provide an example of each patient population for each criterion?

No. Practices with a patient sample that includes both pediatric and adult patients for reporting provide at least one pediatric example and at least one adult example for the criteria outlined in Competency B, but are not required to provide a pediatric example and an adult example for each criterion.

PCMH 2017

5.24.2018 KM 16 Isn’t supplying information on all new prescriptions redundant since the same information is provided by a pharmacy?

No. Although it may be duplicate information, practices cannot assume that the pharmacy provided the information to the patient. Communication and partnership with patients are critical functions of the patient-centered medical home, and practices must ensure that patients/families/caregivers understand why medication was prescribed and its benefits and potential harms to the patient. Additionally, patients might not review prescription information provided by a pharmacy, and information might not be tailored to the needs of the patient/family/caregiver.

PCMH 2017

5.24.2018 CM 04 How is advance care planning different from care planning?

Care planning supports patients identified for care management in CM 01 in managing their care to achieve target goals. Advance care planning (KM 02 I) is the care planning process with an end of life focus to address patient care when they cannot speak for themselves or are at the end of life.
 

PCMH 2017

5.24.2018 KM 12 A May practices use depression screening for both KM 12 A and C?

No. Services must be distinct for each category.

PCMH 2017

5.24.2018 CM 04 What are the parameters for a care plan?

A care plan is based on the acute, chronic and preventive care needs of a patient and can include patient preferences and goals; treatment goals and status; assessment of barriers and strategies to address them; current problems and medications; allergies; and a self-care plan. This criterion requires practices to document a patient-centered view of the care plan and share the plan with the patient. A care plan does not need to be re-created at each visit but must be reviewed and updated as needed.

PCMH 2017

5.24.2018 KM 03 Clarify the language in the guidance stating, “screening for adults for depression with systems in place to assure accurate diagnosis, effective treatment and follow-up.”

The U.S. Preventive Services Task Force (USPSTF) states that adults and adolescents should be screened for depression when a practice has access to services that can be used for follow-up, if there is a positive result (i.e., mental health providers within the practice or external to the practice to whom the practice can refer patients). To meet KM 03, practices are expected to have an approach to follow up and act on results.

PCMH 2017

5.24.2018 KM 09 How does NCQA define “another characteristic of diversity”?

Diversity is a meaningful characteristic of comparison for managing population health that accurately identifies individuals within a non-dominant social system who are underserved. Examples of another characteristic of diversity other than race and ethnicity include, but are not limited to, first ancestry, marital status, employment status, education level, housing status and income.

PCMH 2017

5.24.2018 KM 13 Do PQRS reports or practices who participate in MSSP meet the reporting requirement for KM 13?

No. PQRS reports and Medicare Shared Savings Program (MSSP) would not meet the requirement. For KM 13, practices must demonstrate they participate in an external program that assesses practice-level performance, using a common set of specifications to benchmark results. The external program should also publicly report results and have a process to validate measure integrity. 

PQRS is not a performance-based recognition program and is being rolled into MIPS under the Quality Performance category. The MSSP makes data on Accountable Care Organizations (ACOs), rather than at the practice level, publicly available. Because this criterion is not eligible for shared credit, data is required to be at the practice level. 

While participation in these programs does not meet KM 13, practices can use participation in MSSP to meet QI 19. Practices in Track 1 MSSP, would be eligible for QI 19 A (1 credit), and practices in Track 2 MSSP would be eligible for QI 19 B (2 credits).

PCMH 2017

5.24.2018 KM 12 A May practices use HbA1c measurement for KM 12 A?

No. KM 12 A focuses on preventive care services. HbA1c measurement is appropriate for patients with diabetes and meets criteria for KM 12 C (chronic care services).

PCMH 2017